NEW MICROBIOLOGICA, 33, 117-127, 2010
Evaluation of clinical data and antibody response
following influenza vaccination in patients
with chronic obstructive pulmonary disease
Ceyda Anar1, Can Bicmen2, Sena Yapicioglu1, Ipek Unsal1, Huseyin Halilcolar1, Ufuk Yılmaz1
1Dr. Suat Seren Training and Research, Hospital for Chest Diseases and Surgery, Department of Chest Diseases, Izmir, Turkey;
2Dr. Suat Seren Training and Research, Hospital for Chest Diseases and Surgery, Department of Microbiology, Izmir, Turkey
Chronic obstructive pulmonary disease (COPD)
has become a leading cause of morbidity and
mortality all over the world. It ranks fourth as
cause of death in the world. It is expected to rank
third as a consequence of the increase in smok-
ing rates in 2020 (Murray et al., 1997). Acute ex-
acerbation, which is considered the worsening
of the previous stabile status of the disease is
seen approximately 1-4 times a year.
Exacerbation of the disease is frequently attrib-
utable to infections. Twenty-five to thirty percent
of infections triggering COPD exacerbations are
caused by viruses and also bacteria (Donner,
Araphasan mah. 237
Sok. no:1 kat: 3/7 Izmir - Turkey
1999). Particularly, influenza virus and Strep -
tococcus pneumoniae infections accelerate the
development of pneumonia and secondary bac-
teria and thus increase mortality and morbidity
by causing frequent exacerbation in such pa-
For this reason, influenza and pneumococcal
vaccinations are recommended for the national
and international diagnoses and treatments of
the COPD cases (Turkish Thoracic Society COPD
Study Group, 2000; British Thoracic Society,
2001; WHO Workshop Report, 2003).
Vaccination of patients with chronic airway dis-
eases such as COPD and the other risk groups
increases their life quality and decreases their
hospitalization frequency and infection episodes,
as well as their treatment costs.
In this study, assessment of antibody response
against influenza vaccine and the clinical impact
of the vaccination were investigated. The clinical
and social benefit of the vaccination on the cas-
The present study investigated the antibody response against influenza vaccine and also the efficacy of vaccination on clin-
ical findings in patients with Chronic Obstructive Pulmonary Disease (COPD) following influenza vaccination. A total of
82 cases with COPD (44 cases as vaccinated and 38 cases as unvaccinated) were evaluated clinically and 21 healthy volunteers
were also included in the study as a control group. Influenza (A and B) Ig M and Ig G parameters were analyzed quanti-
tatively in blood samples of the vaccinated group and healthy volunteers by ELISA method once before vaccination and
one month and one year after vaccination. The presence of dyspnoea, increased sputum production and/or purulence were
accepted as criteria of acute exacerbation. The number of hospital presentations was significantly lower in the vaccinated
group and higher in severe cases with COPD in unvaccinated group. Vaccinated cases in the study group experienced sig-
nificantly fewer episodes of pneumonia, hospitalization and intensive care. Quantitative influenza (A and B) antibody IgG
levels significantly increased in these patients as well. In conclusion, seasonal influenza vaccination with the trivalent in-
fluenza split virion vaccine especially in severe or very severe COPD patients who need hospitalization was evaluated as ben-
eficial in clinical use.
KEY WORDS: COPD, Influenza, Vaccine, Antibody response, Clinical evaluation
Received August 10, 2009
Accepted December 23, 2009
es which required serious and intensive care
and/or hospitalization were analyzed on the ba-
sis of the antibody levels and clinical data.
MATERIALS AND METHOD
This prospective study included 82 cases which
were hospitalized in Dr. Suat Seren Training and
Research Hospital for Chest Diseases and Chest
Surgery, with a diagnosis of COPD according to
the GOLD (Global Initiative for Chronic
Obstructive Lung Disease) criteria between
September 2006 and November 2007. The pa-
tients with COPD were selected according to the
1) a forced expiratory volume in one second
(FEV1) of <80% of the forced vital capacity
2) <200 ml and 12% acute increase in FEV1 or
FVC after an inhaled bronchodilator.
Patients with allergy to eggs or patients with as-
sociated malignancy were excluded. Ethics com-
mittee approval was taken along with written in-
formed consent from all the patients.
Sample collection and vaccination
Blood samples were obtained prior to the ad-
ministration of the influenza vaccine.
The patients were administered trivalent influen-
za split virion vaccine (the vaccine included
A/Shangdong/9/93 (H3N2), A/Texas/36/91 (H1N1)
and B/Panama/45/90. Thus the individual groups
whether receiving the vaccine or not were named
as the “vaccinated group” or “unvaccinated
group”. Whole blood samples were obtained from
44 vaccinated patients within the 1stand 12th
months following administration. Additionally,
blood samples were collected from 38 unvacci-
nated patients with COPD and 21 healthy volun-
teers in order to analyze influenza (A and B) Ig M
and Ig G levels. The subgroups used in the analy-
sis were indicated as naïve/not infected (influenza
Ig M and Ig G negative), acute infection (influen-
za Ig M positive and Ig G positive/negative) or pre-
viously infected (not infected in the initial stage of
the study period) (Ig M negative and Ig G posi-
tive). The number of selected individuals in study
(vaccinated and unvaccinated) and healthy vol-
unteers has been shown in Table 1. The mean an-
tibody levels in association with each subgroup
were also added as subinformation under Table 1.
C. Anar, C. Bicmen, S. Yapicioglu, I. Unsal, H. Halilcolar, U. Yılmaz
TABLE 1 - The number of selected individuals in vaccinated and unvaccinated groups and healthy
Vaccinated (N=44) Unvaccinated N=38)
Inf A Inf BInf A Inf B Inf AInf B
naive/not infected2228 20 2445
previously infected2015 1212 1415
1Subgroups are defined as naïve / not infected (Ig M and Ig G both are negative), previously infected (not infected in the initial stage of study period; Ig M negative
and Ig G positive) and acute infection (Ig M positive and Ig G negative /positive). 2Mean antibody levels in association with each subgroup are as follows: Ig M va-
lues (U/mL) for Influenza A in vaccinated, unvaccinated groups and healthy volunteers: Vaccinated Group: 1.2±0.8 (naïve/not infected), 0.0±0.0 (previously infected),
48.9±27.25 (acute infection); Unvaccinated Group: 0.0±0.0 (naïve/not infected), 0.0±0.0 (previously infected), 50.4±22.8 (acute infection); Healthy volunteers: 3.4±2.3
(naïve / not infected), 0.0±0.0 (previously infected), 54.2±18.9 (acute infection). Ig M values (U/mL) for Influenza B in vaccinated, unvaccinated groups and healthy
volunteers: Vaccinated group: 3.0±1.9 (naïve/not infected), 0.0±0.0 (previously infected), 24.6±0.0 (acute infection); Unvaccinated Group: 0.0±0.0, 2.9±0.8, 15.6±8.4;
Healthy volunteers: 3.2±4.5 (naïve/not infected), 2.8±1.4 (previously infected), 28.9±0.0 (acute infection). Ig G values (U/mL) for Influenza A in vaccinated, unvacci-
nated groups and healthy volunteers: Vaccinated Group: 0.0±0.0 (naïve/not infected), 63.5±47.9 (previously infected), 27.6±18.4 (acute infection); Unvaccinated
Group: 0.0±0.0 (naïve/not infected), 65.5±45.9 (previously infected), 44.8±32.9 (acute infection); Healthy volunteers: 0.0±0.0 (naïve/not infected), 77.8±25.7 (pre-
viously infected), 38.2±16.9 (acute infection). Ig G values (U/mL) for Influenza B in vaccinated, unvaccinated groups and healthy volunteers: Vaccinated Group:
2.0±1.1 (naïve/not infected), 41.4±42.8 (previously infected), 0.0±0.0 (acute infection); Unvaccinated Group: 0.0±0.0 (naïve/not infected), 38,9±25,9 (previously infected),
0.0±0.0 (acute infection); Healthy volunteers: 0.0±0.0 (naïve/not infected), 79,1±51,5 (previously infected), 40.7±0.0 (acute infection). Abbreviation; Inf: influenza.
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Antibody response to influenza vaccine and clinical evaluation